Transcription:
What to Know About COVID Vaccines

Alyne: We've all heard the big headline, the COVID vaccine is here. And soon more and more people will be lining up to get the shot and some people will not. What do we need to know about the COVID vaccinations? Here to tell us more as Dr. Robert Hopkins, the Director of General Internal Medicine at UAMS in Little Rock. This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I'm Alyne Ellis. Thanks, Dr. Hopkins, for joining me today.

Dr Robert Hopkins: Happy to be here. Thank you.

Alyne: So we have so many concerns from people as they contemplate taking this vaccine. I'm wondering if you could begin please by telling us a little bit about how they work and the safety measures that have been put in place to study them.

Dr Robert Hopkins: Sure. Well, we currently have a messenger RNA vaccine available. We likely will have another one very soon. What these vaccines have is basically a lipid envelope, a fat envelope and inside that is a particle called messenger RNA. Messenger RNA is a kind of a second level messenger in our genetic protein manufacturing process. And so what happens when you get the vaccine is you get the injection in your arm, the muscle cells then take up that messenger RNA into the outer part of the cell, the cytoplasm.

At that point, the process that our body uses to make proteins takes that messenger RNA up, that codes for the spike protein on the coronavirus. And so those muscle cells make those coronavirus spikes and express those. Your immune system says, "Hey, wait a minute. We've got some foreign protein out here." And the immune system basically acts like it would if you had a coronavirus infection. So it builds antibodies, it builds memory cells, so that your body is then able to attack and prevent an infection with the real coronavirus if you're exposed to it.

The trials that have been done to this point for the current vaccine that's available included almost 45,000 people with a makeup very similar to what we have in this country, you know, all races and ethnicities, men and women, young and old from 16 years of age up to folks in their eighties. They’ve included people who have chronic diseases. And in these trials that were done both in the United States and in other countries, they've shown that this vaccine is highly effective in prevention of severe and symptomatic coronavirus disease out to two months. That's the only endpoint we have at this point. And we're going to continue to evaluate those people going forward.

The vaccine has now been approved for use in this country under a process called emergency use authorization. We have a current public health emergency due to coronavirus and so we're using this vaccine to try to stop that. When we get enough data on effectiveness out another several months, we expect them to be submitted again for final approval, but we need to stop this pandemic now. We don't need to wait another four to six months to get to that process. And that's where we are.

Alyne: I know there are some cold storage potential issues with the vaccine in that it has to be cold until it's almost ready to be administered. What do you have to say to allay our concerns about that?

Dr Robert Hopkins: One of the things that has gotten a fair amount of investment to this point is developing a process where we have a package, a kit, whatever you want to call it, that is sealed with dry ice and it has active temperature monitoring. There's a sensor on those packages that monitor the temperature within so that we make sure that we keep that vaccine at the right temperature.

There's a very nicely detailed set of instructions for healthcare institutions and others that receive the vaccine on how do you refill that with dry ice or to keep it frozen in appropriate commercial freezers until you're ready to prepare it. Once you decide you're ready to go, you open the package, the little multidose vials. You then go through brief process to thaw them. You mix that with sterile saline and then you need to administer that vaccine within a few hours. I think it's six hours is the outside limit. And so you need to have people lined up and ready to go to be vaccinated once you mix it up. So it is detailed and, fortunately, we've got good instructions sent out to everyone that's going to be vaccinating.

Alyne: So what side effects can we expect from the shot?

Dr Robert Hopkins: This vaccine does appear to be reactogenic. It often will cause people to have a sore arm. They can have muscle aches, a fever, headache and fatigue. Those are reasonably common, probably along the order of what we see with our current shingles vaccine. They're usually there for a day or slightly more than a day in those that it happens in, but are usually self-limited. And there's nothing wrong with using Tylenol or anti-inflammatories to treat those symptoms. In fact, we should treat the symptoms.

Alyne: And we've heard that people with severe allergies should not be getting the shot.

Dr Robert Hopkins: Well, the concern was raised when they started using this vaccine in England. There were two individuals who developed what sounds like an allergic reaction. And so people that have severe allergic reactions, people particularly those that have enough allergy that they have to carry an EpiPen, probably need to be monitored for at least a half an hour if they get the vaccine and talk to their healthcare provider before they're vaccinated.

Alyne: What about if you're allergic to something like eggs? I know sometimes the flu shot used to have something in it that would set off a reaction if you were allergic to eggs.

Dr Robert Hopkins: There is no egg protein or egg in these vaccines. The concern is more around people that have had severe allergic reactions with other vaccines.

Alyne: What about if we've already had COVID, should we get this vaccine?

Dr Robert Hopkins: It is recommended that you get the vaccine, whether or not you've had COVID. But if you've had COVID, we based on current studies think that you probably have some protection that lasts out to close to three months. And so generally our advice is if you've had COVID, let's wait till at least near the end, if not the end of that three month interval before we vaccinate.

Alyne: And what about if you currently have COVID with no symptoms? That sounds like perhaps it would be important to be tested to make sure you don't have it when you go to get the shot.

Dr Robert Hopkins: If you have documented COVID without symptoms, I would again wait some time before we get the vaccine. There's not currently a recommendation for us to test people for COVID before we vaccinate them.

Alyne: Now, it's been said that something like 75% of the population needs to get this vaccine in order for the virus to dissipate. Why is that?

Dr Robert Hopkins: Well, we're basing the amount, that 75% on a number of modeling studies. The goal that we have in front of us is we have to have enough of our population immune to this virus in order for us to develop what I prefer to call community immunity, what many others will call herd immunity. That means that we need to have a large proportion of our population who's immune, so that if somebody comes into a place that has the virus, that it's unlikely that they're going to be able to spread that virus to others. And we think that number is going to be somewhere around three quarters of our population.

Alyne: And also that we could get COVID still after having had the shot.

Dr Robert Hopkins: At this point, I don't have definitive answers on that. The trial that was done for this vaccine looked at symptomatic disease. It showed that the vaccine is very effective in preventing people from having COVID with symptoms. We don't yet know whether this prevents asymptomatic COVID disease and that's another area of active study at present.

Alyne: Yeah, I've been referring to this is a shot, but in fact, it's actually two. So can you tell us a little bit about protecting ourselves in between the first shot and the second, and then protecting ourselves after that?

Dr Robert Hopkins: It is absolutely critical that we continue to wear masks, that we continue to socially distance, we continue to stay out of crowds and, of course, our standard hand-washing message. All of those things are going to be critically important from now going forward in those that are vaccinated as well as those that are not. We think based on the trials that after that first dose of vaccine out about two weeks, you probably have some degree of protection. But you need two doses of the vaccine to develop the degree of protection that we've seen in the trials, high-degree protection.

It's about 21 days in between those two doses. And so we're likely to need to continue these public health measures, continue our masks and other preventive measures probably at least into summer. We need to get out to the point where we've got enough of our population vaccinated for us to stop this pandemic.

Alyne: Has it been shown that once we get the first shot that we start shedding the virus the way you would if you really have it so that the other people in our household might be exposed to COVID indirectly?

Dr Robert Hopkins: You do not develop COVID, you do not shed COVID. You know what we're doing with this vaccine is we're having you produce the spikes, the little stubs on the surface of the coronavirus that we've seen in all of the pictures. We do not actually produce or shed virus. So we don't pose any risk to shedding to other people.

Alyne: What other information do you think the public needs to know about this vaccine?

Dr Robert Hopkins: Well, I think there are two or three special groups we need to consider. First are children, those under age 16. We have no data yet on vaccination of people under age 16. I think it's going to be critically important for us to get some trials started with children up to age 16 so that we know the properties of our vaccines, and we're able to protect those children, their teachers and others around them from spread.

Second group that there are some unknowns about is pregnant women. There were not pregnant women intentionally included in the studies. There were some women that became pregnant during the studies. We don't see any adverse events at this point, but we really don't have a whole lot of data on vaccination of pregnant women or the group of women who are breastfeeding. We don't see any reason to suspect harm, but we want to make sure that we're very cautious with those groups. If I had a pregnant woman in front of me, who is a healthcare worker or other person at high risk, we can certainly talk in that one person, individual situation, about the risk and benefit of vaccination.

The third group that we have unknowns about is those that are immunosuppressed. We don't have any signal or any concern that those folks who are at higher risk of adverse effects from the vaccine, but we don't know if they're immunosuppressed, whether they will get the same degree of benefits. We suspect they will get some benefit and protection, but it's probably or it may be less than it would be for those that are not immunosuppressed. So I think we need to think about those groups.

Alyne: And finally, you mentioned that as we know right now both shots will protect us for about a couple months. When do you think we'll know if that protection might last longer than that?

Dr Robert Hopkins: I think that over this next few months, I know that the persons that are in the trial are going to continue to be monitored going out. I suspect that we're going to end the community use of vaccine. We're going to also monitor some of those factors. And as we go forward over our next two to four to six months, I think we'll know more about that duration of protection.

And we also need to consider that likely here in the next couple of weeks, we will have at least one, if not two additional vaccines that are available for use. And that gives me hope that we'll be able to vaccinate more people in the short term and get us closer to that goal of having the majority of our population vaccinated so that we can get back to closer to what we considered normal life before January of 2021.

Alyne: And there's no doubt in your mind that having had this vaccine will keep many people out of the emergency room and the ICU.

Dr Robert Hopkins: Absolutely. And I think that is clearly our goal is to save lives, to keep communities safe. We are not making profit off of this disease. We are here for the public and for public health. And we want to see people able to spend time with their families, with their friends, and we want them to do that in a safe and healthy way.

Alyne: Thank you very much, doctor, for joining me today. It's very interesting to hear the details about what's happening.

Dr Robert Hopkins: Certainly been a pleasure. And everybody, wash your hands and wear your mask.

Alyne: Dr. Robert Hopkins is the Director of General Internal Medicine at UAMS in Little Rock. For more information, visit UAMSHealth.com. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I'm Alyne Ellis. Stay well.